Provider Demographics
NPI:1083110456
Name:HARMSSEN, BROOKE (DO)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:HARMSSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 EAST CHEVY CHASE DRIVE
Mailing Address - Street 2:SUITE 355
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4159
Mailing Address - Country:US
Mailing Address - Phone:747-212-3441
Mailing Address - Fax:747-273-0965
Practice Address - Street 1:1650 EAST CHEVY CHASE DRIVE
Practice Address - Street 2:SUITE 355
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4159
Practice Address - Country:US
Practice Address - Phone:747-212-3441
Practice Address - Fax:747-273-0965
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17897207Q00000X
CA20A17897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine